Physicians underrecognize and undertreat anaphylaxis. Effective interventions are needed to improve physician knowledge and competency regarding evidence-based anaphylaxis diagnosis and management (ADAM). We designed and evaluated an educational program to improve ADAM in pediatrics, internal medicine, and emergency medicine residents from two academic medical centers. Anonymous questionnaires queried participants' demographics, prior ADAM clinical experience, competency, and comfort. A pretest assessing baseline knowledge preceded a 45-minute allergist-led evidence-based presentation, including practice with epinephrine autoinjectors, immediately followed by a posttest. A follow-up test assessed long-term knowledge retention twelve weeks later. 159 residents participated in the pretest, 152 participated in the posttest, and 86 participated in the follow-up test. There were no significant differences by specialty or site. With a possible score of 10, the mean pretest score (7.31 ± 1.50) was lower than the posttest score (8.79 ± 1.29) and follow-up score (8.17 ± 1.72) (P < 0.001 for both). Although participants' perceived confidence in diagnosing or managing anaphylaxis improved from baseline to follow-up (P < 0.001 for both), participants' self-reported clinical experience with ADAM or autoinjector use was unchanged. Allergist-led face-to-face educational intervention improves residents' short-term knowledge and perceived confidence in ADAM. Limited clinical experience or reinforcement contributes to the observed decreased knowledge.

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RATIONALE: DiGeorge syndrome (DGS) is the result of microdeletions of chromosome 22q11.2, resulting in a highly variable phenotype. Since limited clinical information is available, the purpose of this study was to characterize the immunologic status of a cohort of Hispanic DGS patients. METHODS: We studied 50 Hispanic patients diagnosed with DGS (64% confirmed using FISH), ages 0-21 years old (27 females and 23 males, mean age of diagnosis 4.1 6 2.1 years) by retrospective medical record review. Immune studies including lymphocyte subsets, mitogen proliferation, serum immunoglobulins and specific antibody response, and other clinical data were recorded. RESULTS: Nine patients (18%) had normal Tand B lymphocyte numbers, and normal total serum immunoglobulins. Twenty six patients (52%) had decreased T cells (both CD4+ and CD8+). Both T and B lymphocytes were affected in five (10%) patients. Five patients (10%) had decreased vaccine titers, two patients (4%) had hypogammaglobulinemia, and two patients (4%) had reduced, but not absent, proliferative response to mitogens. No patients had complete DGS. A variety of pre-diagnosis infections were found in 20% of patients. Post-diagnosis infections were present in 52%, the majority Otitis Media (28%). Prophylactic antibiotics were given to 20% of the patients. Cardiac malformations were common (82%). Other affected systems included: endocrine (48%), gastrointestinal (54%), and neurologic (56%). Developmental disorders included speech delay (78%) and learning disabilities (54%). CONCLUSIONS: Hispanic patients with partial DGS had diminished T lymphocyte numbers and hypogammaglobulinemia, similar to those previously described in the literature.